Population profile of India: past, present and future.
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Biomedical subjects
Publications and source records attributed to P P Talwar.
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This report provides specific information on the prevalence rates of the most common side effects during the first 3 cycles of use of 3 combination oral contraceptives (OCs) containing 50 mcg estrogen. The probabilities of a symptom occurring for the first time, or persisting once present, during the initial cycles of OC use are given for each of the 3 combined OCs.
A study was undertaken to assess the effects of the study design (frequency and method of inquiry about the side effects) on the reporting of oral contraceptive (OC)-associated side effects. The study found that the one-contact-per-cycle schedule yielded consistently lower rates of side effects than the two-contact-per-cycle schedule. Also, asking subjects about the occurrence of specific symptoms led to the reporting of higher rates of side effects than those obtained by general inquiry. The study suggests that differences in the reported rates of side effects may be due in part to the manner in which the data were collected.
A set of empirical results is used to test a model that assigns rankings to oral contraceptives in terms of relative hormonal potencies. The association between the observed incidence of side effects attributed to excess of estrogen and progestin and their incidence as predicted by the model is analyzed. Results of the study show the model to have incorrectly predicted the observed ranking order of symptoms associated with excess estrogen. Further, while the model correctly predicted the oral contraceptive with the highest progestogenic potency (Ovral), the observed ranking order of the other two preparations is shown to be the reverse of that predicted by the model.
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Shortly after completing an OC cycle the relative hormonal deficit caused by discontinuing the hormones results in withdrawal bleeding. Similarly, if one or more oral contraceptive tablets are missed during a cycle, the resulting deficiency may cause breakthrough bleeding. A lower incidence of breakthrough bleeding on the day after one oral contraceptive tablet is missed and later onset of withdrawal bleeding indicate that a particular OC provides better endometrial control. These two measurements are used as indices to compare the endometrial control provided by Ovral, Norinyl 1/50, and Nortestrin 1 in a study of 480 women at the Planned Parenthood Clinic in Seattle during 1974 and 1975. An analysis of the data shows that the normal chance of breakthrough bleeding on a particular day when one oral contraceptive tablet is not missed on the previous day is 0.017, 0.022, and 0.022 for Ovral, Norinyl, Norlestrin users, but the chance on the day after a contraceptive tablet is missed increased by 13 to 16 times for each of the three OCs. Ovral provides more sustained endometrial control than Norinyl and Norlestrin, however, as indicated by its lower probability of breakthrough bleeding on the day a contraceptive tablet is missed and by its later onset of withdrawal bleeding.
Side effects associated with three oral contraceptives were evaluated in a study in which women were switched to Norlestrin 1 from either Ovral (64 subjects) or Norinyl 1/50 (26 subjects). In the cycle prior to crossover, breast discomfort was more frequent among Norinyl users than among Ovral users. The prevalence of all other reported side effects was not significantly different for Norinyl and Ovral. The crossover to Norlestrin did not significantly change the numbers of patients reporting side effects. By the end of third Norlestrin cycle, rates of all side effects were similar for women who were switched from either Ovral or Norinyl.
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